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J Med Econ ; : 1-7, 2020 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-31782677


Objectives: To evaluate the cost-effectiveness of olmesartan/amlodipine fixed-dose combination vs olmesartan and amlodipine free combination, amlodipine single drug, and valsartan/amlodipine fixed-dose combination in the treatment of hypertensive patients from payer perspective in China.Methods: A Markov model was constructed, which included five health states of hypertensive patients who are aged 35-84 years at baseline and free of cardiovascular disease. Clinical data were obtained from a network meta-analysis. Epidemiology data, adverse events (AEs), cost, and utility data were obtained from the literature. The cost associated with AEs was estimated based on the cost of same symptoms of hypertensive patients in an electric medical record database. The model projected quality-adjusted life years (QALYs) gained, total costs per patient in a 20-year time horizon, and incremental cost-effectiveness ratios. Probability sensitivity analyses (PSA) and one-way sensitivity analyses were conducted for the main parameters to test the robustness of the model.Results: Compared to olmesartan and amlodipine free combination, amlodipine, and valsartan/amlodipine fixed-dose combination, treatment with olmesartan/amlodipine fixed-dose combination led to fewer CVD events and deaths; resulted in an incremental cost of ¥-5,439 ($-791.36), ¥6,530 ($950.09), and ¥-1,019 ($-148.26) and gained additional QALYs of 0.052, 0.094, and 0.037 per patient, respectively. Compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, olmesartan/amlodipine fixed-dose combination was dominant. Compared with amlodipine alone, the incremental cost-effectiveness ratios were below the WHO recommended cost-effectiveness threshold, indicating the olmesartan/amlodipine fixed-dose combination was a cost-effective option for hypertensive patients in China. The 10-years' time horizon scenario analysis showed similar results to the 20-years' time horizon. Probabilistic sensitivity analysis and one-way sensitivity analyses showed the robustness of the model results.Conclusions: Olmesartan/amlodipine fixed-dose combination confers better health outcomes and costs less compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, and is cost-effective compared to amlodipine for hypertension treatment in China.

J Altern Complement Med ; 24(6): 564-569, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29431470


OBJECTIVE: The purpose of this study was to evaluate the cost-effectiveness of Safflower Yellow Injection (SYI) plus conventional treatment (SYI group) versus conventional treatment only (conventional group) for the treatment of stable angina pectoris (SAP) patients in China. METHODS: A decision-tree model was constructed and the treatment impact was estimated for up to 1 year. The data, including treatment effectiveness, episodes of angina pectoris (AP)-associated hospitalization and its in-hospital mortality, mortality rate of heart diseases, and cost of hospitalization, were obtained from literature. The costs of medications were calculated based on their average bidding prices in China. The authors also conducted a doctor survey to obtain cost associated with death of cardiovascular events. Sensitivity analysis was performed to evaluate the robustness of the results. RESULTS: SAP patients in the SYI group (n = 1000) gained incremental 66.01 quality-adjusted life years (QALYs) at a cost of $250,294 compared with patients receiving conventional treatment, yielding an incremental cost-effectiveness ratio of $3,791/QALY, which was less than Chinese GDP per capita and is considered to be highly cost effective per WHO-recommended economic evaluation guidelines. Sensitivity analysis indicated that the results were robust with variations for all major parameters of the model. CONCLUSION: SYI combined with conventional treatment is a highly cost-effective therapy option compared with the conventional treatment for treatment of SAP in China.

Angina Estável/tratamento farmacológico , Chalcona/análogos & derivados , Análise Custo-Benefício , Medicina Tradicional Chinesa , Chalcona/administração & dosagem , Chalcona/economia , Chalcona/uso terapêutico , China/epidemiologia , Árvores de Decisões , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade
J Med Econ ; 21(1): 60-65, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28851245


OBJECTIVE: This study is to evaluate the costs, clinical efficacy, and social benefits of a patient assistance program (PAP) implemented by the China Primary Healthcare Foundation for the use of pemetrexed as a first-line non-squamous non-small cell lung cancer (NSCLC) maintenance therapy in China. METHODS: A survival analysis was conducted on the clinical data of 1,366 patients who participated in the PAP. The progression-free survival (PFS) and median maintenance treatment cycle of pemetrexed were analyzed. A 36-month Markov model from a payer's perspective was constructed to analyze the cost and effectiveness associated with the PAP for pemetrexed. The inputs of the model were sourced from the PAP clinical database and published literature. The study estimated the incremental quality adjusted life-years (QALYs) (pemetrexed plus best supportive care [BSC] vs BSC only), the cost saving of the PAP, the impact on the percentage of catastrophic health expenditures (CHE), and poverty headcount ratio (HCR). RESULTS: The median of PFS and maintenance treatment cycles were 187 days and five cycles (total nine cycles, which included four cycles of induction therapy), respectively. The pemetrexed plus BSC treatment with PAP resulted in an additional 0.12 QALYs over BSC only. The total cost was $48,034.46 and $96,191.57 for the patients who had or had not joined the PAP in 3 years, respectively. Compared to the patients without PAP, the percentage of CHE and HCR with PAP was reduced from 98.39% to 19.91% and 66.98% to 4.89%, respectively, indicating that the PAP substantially decreased the number of patients who had CHE and fallen into poverty. CONCLUSION: The study concluded that the pemetrexed PAP generated noticeable clinical and economic benefits to society and to patients. The program also increased patients' compliance with chemotherapy by allowing patients, for whom the pemetrexed treatment was unaffordable, to continue to receive it.

Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Análise Custo-Benefício , Neoplasias Pulmonares/tratamento farmacológico , Programas Nacionais de Saúde/economia , Pemetrexede/economia , Pemetrexede/uso terapêutico , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , China , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Farmacoeconomia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
Phys Chem Chem Phys ; 12(36): 10846-56, 2010 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-20657941


Singlet and triplet potential energy surfaces for the reactions of oxygen atoms ((3)P and (1)D) with CF(3)CN have been studied computationally to evaluate the reaction mechanisms, possible products, and rate constants. On the triplet surface, six kinds of pathway are revealed, namely: direct fluorine abstraction, C-addition/elimination, N-addition/elimination, substitution, insertion and F-migration. The results show that the reaction should occur mainly through the C-addition/elimination mechanism involving the chemically activated CF(3)C(O)N* intermediate, and the major products are CF(3) and NCO. The rate constants for C-addition/elimination channel of the reaction of O((3)P) with CF(3)CN have been determined by using RRKM statistical rate theory and compared with the experimental data. On the singlet surface, the atomic oxygen can easily insert into the C-F or C-C bond of CF(3)CN, forming the insertion intermediates FOCF(2)CN and CF(3)OCN, and O((1)D) can add to the carbon or nitrogen atom of the CN group in CF(3)CN, forming the addition intermediates CF(3)C(O)N and CF(3)CNO; both approaches are found to be barrierless. The decomposition and isomerization of some intermediates were also modeled at the QCISD(T)/6-311+G(2df)//B3LYP/6-311+G(d) level for the better understanding of the O((1)D) with CF(3)CN chemistry. The decomposition products CF(3) and NCO arising from CF(3)OCN and CF(3)NCO are the dominant species. Further comparison with similar reactions is also summarized.